Tagged Mobile Applications

Is ‘Femtech’ the Next Big Thing in Health Care?

Start-ups and tech companies are creating products to address women’s health care needs. It’s still a small segment of the market, but growing.

This article is part of our new series on the Future of Health Care, which examines changes in the medical field.

Women represent half of the planet’s population. Yet tech companies catering to their specific health needs represent a minute share of the global technology market.

In 2019, the “femtech” industry — software and technology companies addressing women’s biological needs — generated $820.6 million in global revenue and received $592 million in venture capital investment, according to PitchBook, a financial data and research company. That same year, the ride-sharing app Uber alone raised $8.1 billion in an initial public offering. The difference in scale is staggering, especially when women spend an estimated $500 billion a year on medical expenses, according to PitchBook.

Tapping into that spending power, a multitude of apps and tech companies have sprung up in the last decade to address women’s needs, including tracking menstruation and fertility, and offering solutions for pregnancy, breastfeeding and menopause. Medical start-ups also have stepped in to prevent or manage serious conditions such as cancer.

“The market potential is huge,” said Michelle Tempest, a partner at the London-based health care consultancy Candesic and a psychiatrist by training. “There’s definitely an increasing appetite for anything in the world which is technology, and a realization that female consumer power has arrived — and that it’s arrived in health care.”

She said one reason women-related needs had not been focused on in the field of technology was that life sciences research was overwhelmingly “tailored to the male body.” In 1977, the U.S. Food and Drug Administration excluded women of childbearing age from taking part in drug trials. . Since then, women have been underrepresented in drug trials, Dr. Tempest said, because of a belief that fluctuations caused by menstrual cycles could affect trial results, and also because if a woman got pregnant after taking a trial drug, the drug could affect the fetus. As a result, she noted, “we do lag behind men.”

Ida Tin, co-founder of Clue, which offers a period and ovulation tracking app.
Ida Tin, co-founder of Clue, which offers a period and ovulation tracking app.via Clue

The term “femtech” was coined by Ida Tin, the Danish-born founder of Clue, a period and ovulation tracking app established in Germany in 2013. In an article on the company’s website, Ms. Tin recalled how she first had the idea for the app. In 2009, she found herself holding a cellphone in one hand and a small temperature-taking device in the other and wishing she could merge the two to track her fertility days, rather than manually having to note her temperature on a spreadsheet.

Clue allows women to do exactly that with a few taps on their smartphone. Today, the company has a lot of competition in the period- and fertility-tracking area. And plenty of other women-specific tools have come onto the market. Elvie, a London-based company, has marketed a wearable breast pump and a pelvic exercise trainer and app, both using smart technology. Another strand of femtech known as “menotech” aims to improve women’s lifestyles as they go through menopause, providing access to telemedicine, and information and data that women can tap into.

Clue’s period and ovulation app. Ms. Tin had the idea when she found herself holding a cellphone in one hand and a small temperature-taking device in the other.Clue

Finally, there are medical technology companies focused on cancer that affects women, such as cervical cancer and breast cancer.

According to the World Health Organization, cervical cancer is the fourth most common cause of cancer among women around the world. In 2018, about 570,000 women had it, and as many as 311,000 died. The W.H.O. in November announced a program to eradicate the disease completely by the year 2030.

MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. A smart colposcope — a portable imaging device that’s one and a half times the size of a smartphone — is used to take a photograph of a woman’s cervix from a distance of about a meter (3 feet). The image is then transmitted to the cloud via a smartphone, where artificial intelligence is used to identify normal or abnormal cervical findings.

A diagnosis is delivered in about 60 seconds — compared to the weeks it takes to receive the results of a standard smear test (which, in developing countries, extends to months.) In addition to this screening, doctors still use smear tests.

The technology was recently used to screen 9,000 women during a three-month period in the Dominican Republic as part of a government-led campaign, the company announced last month. Another 50,000 women are expected be screened in the next six months.

Leon Boston, the South African-born chief executive of MobileODT, said the privately owned company was selling into about 20 different countries including the United States, India, South Korea and Brazil, and is going into a fund-raising round to build on its initial seed money of $24 million.

But the leading cause of cancer among women all over the world is breast cancer. One French start-up is focused on dealing with its aftermath. Lattice Medical has developed a 3-D printed hollow breast implant that allows for the regeneration of tissue and is absorbed by the body over time.

How it works: Post-mastectomy, the surgeon harvests a small flap of fat from the area immediately around the woman’s breast and places it inside the 3-D-printed bioprosthesis. That piece of tissue grows inside the implant, and eventually fills it out. In the meantime, the 3-D-printed shell disappears completely 18 months later.

So far, tests on animals have been encouraging, said Julien Payen, the company’s co-founder and chief executive. Clinical trials on women are expected to start in 2022, with the aim of getting the product into the market in 2025, he added.

Asked why the global femtech market was so small for technology companies, Mr. Boston said it was partly because of the “high level of regulation” involved in medical technology.

MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. MobileODT

“If your technology is incorrect and comes up with the wrong result, a woman who thinks she’s not positive for cervical cancer is actually positive,” he said. As a result, “the world of medical technology is slow to move.”

Still, prospects are favorable, according to Mr. Boston. “It’s very rare to have a totally barren market open for full potential, as we have today in medical technology,” he said.

The data forecasts appear to back that up. According to a March 2020 report by Frost & Sullivan, a research and strategy consultancy, revenue from femtech is expected to reach $1.1 billion by 2024.

Mr. Payen explained that for the femtech market to expand and develop, there have to be many more tech companies offering genuine health benefits to women, not just well-being apps crowding the market and adding little in terms of health or medical value. He cited the example of Endodiag, a French medical technology company that allows early diagnosis of endometriosis and a better management of the condition.

Either way, said Mr. Payen, the industry showed promise.

“Over the last 10 years, thanks to #MeToo and other movements, women are being listened to and heard more than ever before,” Mr. Payen said. And “more and more women are running companies and investment funds,” he added.

“In 10 or 15 years from now, as a new generation takes over, things will have changed even more radically,” he said. “Femtech is clearly poised to grow.”

How Children Read Differently From Books vs. Screens

The Checkup

How Children Read Differently From Books vs. Screens

Scrolling may work for social media, but experts say that for school assignments, kids learn better if they slow down their reading.

Credit…Cristina Spanò

  • March 16, 2021, 11:20 a.m. ET

In this pandemic year, parents have been watching — often anxiously — their children’s increasing reliance on screens for every aspect of their education. It can feel as if there’s no turning back to the time when learning involved hitting the actual books.

But the format children read in can make a difference in terms of how they absorb information.

Naomi Baron, who is professor emerita of linguistics at American University and author of a new book, “How We Read Now: Strategic Choices for Print, Screen and Audio,” said, “there are two components, the physical medium and the mind-set we bring to reading on that medium — and everything else sort of follows from that.”

Because we use screens for social purposes and for amusement, we all — adults and children — get used to absorbing online material, much of which was designed to be read quickly and casually, without much effort. And then we tend to use that same approach to on-screen reading with harder material that we need to learn from, to slow down with, to absorb more carefully. A result can be that we don’t give that material the right kind of attention.

For early readers

With younger children, Professor Baron said, it makes sense to stick with print to the extent that it is possible. (Full disclosure: As the national medical director of the program Reach Out and Read, I believe fervently in the value of reading print books to young children.) Print, she said, makes it easier for parents and children to interact with language, questions and answers, what is called “dialogic reading.” Further, many apps and e-books have too many distractions.

Dr. Jenny Radesky, a developmental behavioral pediatrician who is an assistant professor of pediatrics at Michigan Medicine C.S. Mott Children’s Hospital in Ann Arbor, said that apps designed to teach reading in the early years of school rely on “gamification meant to keep children engaged.” And though they do successfully teach core skills, she said, “what has been missing in remote schooling is the classroom context, the teacher as meaning maker, to tie it all together, helping it be more meaningful to you, not just a bunch of curricular components you’ve mastered.”

Any time that parents are able to engage with family reading time is good, using whatever medium works best for them, said Dr. Tiffany Munzer, also a developmental behavioral pediatrician at Mott Children’s Hospital, who has studied how young children use e-books. However, Dr. Munzer was the lead author on a 2019 study that found that parents and toddlers spoke less overall, and also spoke less about the story when they were looking at electronic books compared with print books, and another study that showed less social back-and-forth — the toddlers were more likely to be using the screens by themselves.

“There are some electronic books that are designed really well,” Dr. Munzer said, pointing to a study of one book (designed by PBS) that included a character who guided parents in engaging their children around the story. “On the other hand, there’s research that suggests that a lot of what you find in the most popular apps have all these visually salient features which distracts from the core content and makes it harder for kids to glean the content, harder for parents to have really rich dialogue.”

Still, she said, it’s not fair to expect parents to navigate this technology — it should be the job of the software developers to design electronic books that encourage language and interactions, tailored to a child’s developmental level.

With preschoolers as opposed to toddlers, Professor Baron said, “there are now beginning to be some smarter designs where the components of the book or the app help further the story line or encourage dialogic reading — that’s now part of the discussion.”

Dr. Radesky, who was involved in the research projects with Dr. Munzer, talked about the importance of helping children master reading that goes beyond specific remembered details — words or characters or events — so a child is “able to integrate knowledge gained from the story with life experience.” And again, she said, that isn’t what is stressed in digital design. “Stuff that makes you think, makes you slow down and process things deeply, doesn’t sell, doesn’t get the most clicks,” she said.

Parents can help with this when their children are young, Dr. Radesky said, by discussing the story and asking the questions that help children draw those connections.

For school-age kids

“When kids enter digital spaces, they have access to an infinite number of platforms and websites in addition to those e-books you’re supposed to be reading,” Dr. Radesky said. “We’ve all been on the ground helping our kids through remote learning and watching them not be able to resist opening up that tab that’s less demanding.”

“All through the fall I was constantly helping families manage getting their child off YouTube,” Dr. Radesky said. “They’re bored, it’s easy to open up a browser window,” as adults know all too well. “I’m concerned that during remote learning, kids have learned to orient toward devices with this very skimmy partial attention.”

Professor Baron said that in an ideal world, children would learn “how to read contiguous text for enjoyment, how to stop, how to reflect.”

In elementary school, she said, there’s an opportunity to start a conversation about the advantages of the different media: “It goes for print, goes for a digital screen, goes for audio, goes for video, they all have their uses — we need to make kids aware that not all media are best suited to all purposes.” Children can experiment with reading digitally and in print, and can be encouraged to talk about what they perceived and what they enjoyed.

Dr. Radesky talked about helping children develop what she called “metacognition,” in which they ask themselves questions like, “how does my brain feel, what does this do to my attention span?” Starting around the age of 8 to 10, she said, children are developing the skills to understand how they stay on task and how they get distracted. “Kids recognize when the classroom gets too busy; we want them to recognize when you go into a really busy digital space,” she said.

For older readers

In experiments with middle school and university students asked to read a passage and then be tested on it, Professor Baron said, there is a mismatch between how they feel they learn and how they actually perform.

Students who think they read better — or more efficiently — on the screen will still do better on the test if they have read the passage on the page. And college students who print out articles, she said, tend to have higher grades and better test scores. There is also research to suggest that university students who used authentic books, magazines or newspapers to write an essay wrote more sophisticated essays than those just given printouts.

With complex text in any format, slowing down helps. Professor Baron said that parents can model this at home, sitting and relaxing over a book, reading without rushing and perhaps generally de-emphasizing speed when it comes to learning. Teachers can be trained to help students develop “deep reading, mindful, focusing on the text,” she said.

For example, students can be trained in digital annotation, highlighting but also making marginal notes, so that they have to slow down and add their own words. “We’ve known that for years, we’ve done it with print, we have to realize that if you want to learn something from a digital document, annotate,” she said.

There are also studies that suggest that reading comprehension is better onscreen when readers page down — that is, when they see a page (or a screen) of text at a time, and then move to the next, rather than continuously scrolling through text.

Seeing information on the page may help a student see a book as something with a structure, rather than just text from which you grab some quick information.

No one is going to take screens out of children’s lives, or out of their learning. But the more we exploit the rich possibilities of digital reading, the more important it may be to encourage children to try out reading things in different ways, and to discuss what it feels like, and perhaps to have adults reflect on their own reading habits. Reading on digital devices can motivate recalcitrant readers, Professor Baron said, and there are many good reasons to do some of your reading on a screen.

But, of course, it’s a different experience.

“There’s a physicality,” Professor Baron said. “So many young people talk about the smell of books, talk about reading print as being ‘real’ reading.”

How to Get a Peloton-Style Workout Without Splurging

Tech Fix

How to Get a Peloton-Style Workout Without Splurging

Don’t want to pay $1,900 for a Peloton bike, plus a subscription fee for classes? Here are ways to reduce the cost of using tech to exercise at home.

Lisa Whitney of Reno, Nev., has created her version of a do-it-yourself Peloton bike. 
Lisa Whitney of Reno, Nev., has created her version of a do-it-yourself Peloton bike. Credit…Max Whittaker for The New York Times
Brian X. Chen

  • March 3, 2021, 5:00 a.m. ET

Lisa Whitney, a dietitian in Reno, Nev., came across the deal of a lifetime about two years ago. A fitness studio was going out of business and selling its equipment. She scored an indoor exercise bike for $100.

Ms. Whitney soon made some additions to the bike. She propped her iPad on the handlebars. Then she experimented with online cycling classes streamed on YouTube and on the app for Peloton, a maker of internet-connected exercise devices that offers interactive fitness classes.

Ms. Whitney had no desire to upgrade to one of Peloton’s $1,900-plus luxury exercise bikes, which include a tablet to stream classes and sensors that track your speed and heart rate. So she further modified her bike to become a do-it-yourself Peloton, buying sensors and indoor cycling shoes.

The grand total: about $300, plus a $13 monthly subscription to Peloton’s app. Not cheap, but a significant discount to what she might have paid.

“I’m happy with my setup,” Ms. Whitney, 42, said. “I really don’t think upgrading would do much.”

The pandemic, which has forced many gyms to shut down, has driven hordes of people to splurge on luxury items like Peloton’s bikes and treadmills so they can work out at home. Capitalizing on this trend, Apple last year released Apple Fitness Plus, an instructional fitness app that is exclusively offered to people who own an Apple Watch, which requires an iPhone to work.

But all of that can be expensive. The minimum prices of an Apple Watch and iPhone add up to $600, and Apple Fitness Plus costs $10 a month. Then to stream classes on a big-screen TV instead of a phone while you exercise, you need a streaming device such as an Apple TV, which costs about $150. The full Peloton experience is even pricier.

With the economy in a funk, many of us are trying to tighten our spending while maintaining good health. So I experimented with how to minimize the costs of doing video-instructed workouts at home, talked to tinkerers and assessed the pros and cons.

Here’s what I learned.

To measure her energy output, Ms. Whitney added a sensor that tracks the bike’s rotations per minute.Credit…Max Whittaker for The New York Times
She also straps a heart rate monitor to her arm as part of her routine.Credit…Max Whittaker for The New York Times

The Pros and Cons of Free

To start my experiment for working out at home on the cheap, the first question I tackled was whether to subscribe to a fitness app or stream classes from YouTube for free. Both largely provide videos of instructors guiding you through workouts.

So I bought an $8 yoga mat and a $70 pair of adjustable dumbbells and turned on my TV, which includes the YouTube app. I then subscribed to three of the most popular YouTube channels that have free content for exercising at home: Yoga With Adriene, Fitness Blender and Holly Dolke.

One immediate downside was almost too much content — often hundreds of videos per YouTuber — making it difficult to pick a workout. Even when I finally chose a video, I learned I had to brace myself for some quality issues.

In the Yoga With Adriene channel, for instance, I selected the video “Yoga for When You Feel Dead Inside,” which felt appropriate for the time we are living in. The video looked good, but at times the instructor’s voice sounded muffled.

Production problems were more visible in the Holly Dolke channel, which has a collection of intense workouts that you can do without any equipment. When I tried the video “Muffin Top Melter,” an instructor in the background demonstrated how to do a more challenging version of each exercise, but the other instructor, in the foreground, constantly blocked her.

Then there were the ads. As I lifted weights while following a 10-minute fat-burning workout from Fitness Blender, YouTube interrupted the video to play an ad for Dawn soap. That left me holding a dumbbell above the back of my neck while I waited for the ad to end.

Those issues aside, I was able to do all of the exercises demonstrated by these YouTubers, and they left me winded and sweaty. For the cost of free, I can’t complain much. Most important, Yoga With Adriene succeeded in making me feel less dead inside.

What You Get When You Pay

To compare the free YouTube exercise videos with the paid experience, I subscribed to Peloton and Apple Fitness Plus on my Apple TV set-top box. I did workouts using both products for the last two months.

Peloton and Apple Fitness Plus addressed many of the problems plaguing the free exercise content.

For one, workouts were organized into categories by the type of workout, including yoga, strength training and core, and then by the difficulty or duration of the workout. It took little time to choose a workout.

Peloton’s app organizes workouts by category, difficulty and duration.
Peloton’s app organizes workouts by category, difficulty and duration.Credit…Brian X. Chen

In both Peloton and Apple Fitness Plus, video and audio quality were very clear, and the workouts were shot at various angles to get a good look at what the instructors were doing. The bonus of Fitness Plus was that my heart rate and calories burned were displayed on both my Apple Watch and the TV screen.

In short, paying those subscriptions provided convenience and polish, which led to a more pleasant workout. I concluded that Peloton’s videos were worth paying $13 a month. And $10 a month is reasonable for Apple Fitness Plus, but only if you already have an Apple Watch and iPhone.

Apple Fitness Plus on an iPhone and Apple Watch.Credit…Apple

Making a D.I.Y. Peloton

So what about exercise equipment like spin bikes? If you want the tech frills of a Peloton but don’t want to spend on the equipment, there were two main approaches.

To go the cheapest route, you can make use of a bicycle you already have. Here’s where home tinkerers can be especially crafty and resourceful.

Take Omar Sultan, a manager at the networking company Cisco. He modified his road bike with a few add-ons: a bike trainer, which secured the rear wheel and bike frame and costs roughly $100; a $40 Wahoo cadence sensor that tracked his energy output and speed and transmitted the data to a smartphone; and a heart rate monitor that strapped around his chest, such as the $90 Polar H10. Then he used a streaming device to follow Peloton classes on his TV.

“The D.I.Y. setup is 80 percent of the way there” to a Peloton, Mr. Sultan said.

The more expensive option was to buy an indoor exercise bike and use a tablet or phone to stream cycling classes via YouTube or the Peloton app, as Ms. Whitney did. The $700 IC7.9, for example, includes a cadence sensor and a holder for your tablet. You could then buy a heart rate monitor and a pair of $100 indoor cycling shoes that clip into the pedals.

But if you use your own bicycle or a modified spin bike and try Peloton’s app, you won’t be able to participate in the app’s so-called leader board, which shows a graphic of your progress compared with other Peloton users online.

With a D.I.Y. bike, it can also be difficult to figure out how to shift gears to simulate when the instructor is telling you to turn up the resistance — like when you are pretending to ride up a hill.

Nicole Odya, a nurse practitioner in Chicago who modified a high-end indoor bike, the Keiser M3i, said there were major upsides to the D.I.Y. route. Using her own iPad, she has the flexibility to choose whatever fitness apps she wants to use, such as Zwift and mPaceLine. It also gave her the freedom to customize her bike, so she swapped out the stock pedals for better ones.

“I didn’t want to be locked into their platform,” she said of Peloton.

How to Get a Peloton-Style Workout Without Splurging

Tech Fix

How to Get a Peloton-Style Workout Without Splurging

Don’t want to pay $1,900 for a Peloton bike, plus a subscription fee for classes? Here are ways to reduce the cost of using tech to exercise at home.

Lisa Whitney of Reno, Nev., has created her version of a do-it-yourself Peloton bike. 
Lisa Whitney of Reno, Nev., has created her version of a do-it-yourself Peloton bike. Credit…Max Whittaker for The New York Times
Brian X. Chen

  • March 3, 2021, 5:00 a.m. ET

Lisa Whitney, a dietitian in Reno, Nev., came across the deal of a lifetime about two years ago. A fitness studio was going out of business and selling its equipment. She scored an indoor exercise bike for $100.

Ms. Whitney soon made some additions to the bike. She propped her iPad on the handlebars. Then she experimented with online cycling classes streamed on YouTube and on the app for Peloton, a maker of internet-connected exercise devices that offers interactive fitness classes.

Ms. Whitney had no desire to upgrade to one of Peloton’s $1,900-plus luxury exercise bikes, which include a tablet to stream classes and sensors that track your speed and heart rate. So she further modified her bike to become a do-it-yourself Peloton, buying sensors and indoor cycling shoes.

The grand total: about $300, plus a $13 monthly subscription to Peloton’s app. Not cheap, but a significant discount to what she might have paid.

“I’m happy with my setup,” Ms. Whitney, 42, said. “I really don’t think upgrading would do much.”

The pandemic, which has forced many gyms to shut down, has driven hordes of people to splurge on luxury items like Peloton’s bikes and treadmills so they can work out at home. Capitalizing on this trend, Apple last year released Apple Fitness Plus, an instructional fitness app that is exclusively offered to people who own an Apple Watch, which requires an iPhone to work.

But all of that can be expensive. The minimum prices of an Apple Watch and iPhone add up to $600, and Apple Fitness Plus costs $10 a month. Then to stream classes on a big-screen TV instead of a phone while you exercise, you need a streaming device such as an Apple TV, which costs about $150. The full Peloton experience is even pricier.

With the economy in a funk, many of us are trying to tighten our spending while maintaining good health. So I experimented with how to minimize the costs of doing video-instructed workouts at home, talked to tinkerers and assessed the pros and cons.

Here’s what I learned.

To measure her energy output, Ms. Whitney added a sensor that tracks the bike’s rotations per minute.Credit…Max Whittaker for The New York Times
She also straps a heart rate monitor to her arm as part of her routine.Credit…Max Whittaker for The New York Times

The Pros and Cons of Free

To start my experiment for working out at home on the cheap, the first question I tackled was whether to subscribe to a fitness app or stream classes from YouTube for free. Both largely provide videos of instructors guiding you through workouts.

So I bought an $8 yoga mat and a $70 pair of adjustable dumbbells and turned on my TV, which includes the YouTube app. I then subscribed to three of the most popular YouTube channels that have free content for exercising at home: Yoga With Adriene, Fitness Blender and Holly Dolke.

One immediate downside was almost too much content — often hundreds of videos per YouTuber — making it difficult to pick a workout. Even when I finally chose a video, I learned I had to brace myself for some quality issues.

In the Yoga With Adriene channel, for instance, I selected the video “Yoga for When You Feel Dead Inside,” which felt appropriate for the time we are living in. The video looked good, but at times the instructor’s voice sounded muffled.

Production problems were more visible in the Holly Dolke channel, which has a collection of intense workouts that you can do without any equipment. When I tried the video “Muffin Top Melter,” an instructor in the background demonstrated how to do a more challenging version of each exercise, but the other instructor, in the foreground, constantly blocked her.

Then there were the ads. As I lifted weights while following a 10-minute fat-burning workout from Fitness Blender, YouTube interrupted the video to play an ad for Dawn soap. That left me holding a dumbbell above the back of my neck while I waited for the ad to end.

Those issues aside, I was able to do all of the exercises demonstrated by these YouTubers, and they left me winded and sweaty. For the cost of free, I can’t complain much. Most important, Yoga With Adriene succeeded in making me feel less dead inside.

What You Get When You Pay

To compare the free YouTube exercise videos with the paid experience, I subscribed to Peloton and Apple Fitness Plus on my Apple TV set-top box. I did workouts using both products for the last two months.

Peloton and Apple Fitness Plus addressed many of the problems plaguing the free exercise content.

For one, workouts were organized into categories by the type of workout, including yoga, strength training and core, and then by the difficulty or duration of the workout. It took little time to choose a workout.

Peloton’s app organizes workouts by category, difficulty and duration.
Peloton’s app organizes workouts by category, difficulty and duration.Credit…Brian X. Chen

In both Peloton and Apple Fitness Plus, video and audio quality were very clear, and the workouts were shot at various angles to get a good look at what the instructors were doing. The bonus of Fitness Plus was that my heart rate and calories burned were displayed on both my Apple Watch and the TV screen.

In short, paying those subscriptions provided convenience and polish, which led to a more pleasant workout. I concluded that Peloton’s videos were worth paying $13 a month. And $10 a month is reasonable for Apple Fitness Plus, but only if you already have an Apple Watch and iPhone.

Apple Fitness Plus on an iPhone and Apple Watch.Credit…Apple

Making a D.I.Y. Peloton

So what about exercise equipment like spin bikes? If you want the tech frills of a Peloton but don’t want to spend on the equipment, there were two main approaches.

To go the cheapest route, you can make use of a bicycle you already have. Here’s where home tinkerers can be especially crafty and resourceful.

Take Omar Sultan, a manager at the networking company Cisco. He modified his road bike with a few add-ons: a bike trainer, which secured the rear wheel and bike frame and costs roughly $100; a $40 Wahoo cadence sensor that tracked his energy output and speed and transmitted the data to a smartphone; and a heart rate monitor that strapped around his chest, such as the $90 Polar H10. Then he used a streaming device to follow Peloton classes on his TV.

“The D.I.Y. setup is 80 percent of the way there” to a Peloton, Mr. Sultan said.

The more expensive option was to buy an indoor exercise bike and use a tablet or phone to stream cycling classes via YouTube or the Peloton app, as Ms. Whitney did. The $700 IC7.9, for example, includes a cadence sensor and a holder for your tablet. You could then buy a heart rate monitor and a pair of $100 indoor cycling shoes that clip into the pedals.

But if you use your own bicycle or a modified spin bike and try Peloton’s app, you won’t be able to participate in the app’s so-called leader board, which shows a graphic of your progress compared with other Peloton users online.

With a D.I.Y. bike, it can also be difficult to figure out how to shift gears to simulate when the instructor is telling you to turn up the resistance — like when you are pretending to ride up a hill.

Nicole Odya, a nurse practitioner in Chicago who modified a high-end indoor bike, the Keiser M3i, said there were major upsides to the D.I.Y. route. Using her own iPad, she has the flexibility to choose whatever fitness apps she wants to use, such as Zwift and mPaceLine. It also gave her the freedom to customize her bike, so she swapped out the stock pedals for better ones.

“I didn’t want to be locked into their platform,” she said of Peloton.

Could a Smell Test Screen People for Covid?

Could a Smell Test Screen People for Covid?

A new modeling study hints that odor-based screens could quash outbreaks. But some experts are skeptical it would work in the real world.

A health worker in Altos de San Lorenzo, a neighborhood outside Buenos Aires, Argentina, administered a smell test last year.
A health worker in Altos de San Lorenzo, a neighborhood outside Buenos Aires, Argentina, administered a smell test last year.Credit…Alejandro Pagni/Agence France-Presse — Getty Images
Katherine J. Wu

  • Jan. 19, 2021, 5:49 p.m. ET

In a perfect world, the entrance to every office, restaurant and school would offer a coronavirus test — one with absolute accuracy, and able to instantly determine who was virus-free and safe to admit and who, positively infected, should be turned away.

That reality does not exist. But as the nation struggles to regain a semblance of normal life amid the uncontrolled spread of the virus, some scientists think that a quick test consisting of little more than a stinky strip of paper might at least get us close.

The test does not look for the virus itself, nor can it diagnose disease. Rather, it screens for one of Covid-19’s trademark signs: the loss of the sense of smell. Since last spring, many researchers have come to recognize the symptom, which is also known as anosmia, as one of the best indicators of an ongoing coronavirus infection, capable of identifying even people who don’t otherwise feel sick.

A smell test cannot flag people who contract the coronavirus and never develop any symptoms at all. But in a study that has not yet been published in a scientific journal, a mathematical model showed that sniff-based tests, if administered sufficiently widely and frequently, might detect enough cases to substantially drive transmission down.

Daniel Larremore, an epidemiologist at the University of Colorado, Boulder, and the study’s lead author, stressed that his team’s work was still purely theoretical. Although some smell tests are already in use in clinical and research settings, the products tend to be expensive and laborious to use and are not widely available. And in the context of the pandemic, there is not yet real-world data to support the effectiveness of smell tests as a frequent screen for the coronavirus. Given the many testing woes that have stymied pandemic control efforts so far, some experts have been doubtful that smell tests could be distributed widely enough, or made sufficiently cheat-proof, to reduce the spread of infection.

“I have been intimately involved in pushing to get loss of smell recognized as a symptom of Covid from the beginning,” said Dr. Claire Hopkins, an ear, nose and throat surgeon at Guy’s and St. Thomas’ Hospitals in the United Kingdom and an author of a recent commentary on the subject in The Lancet. “But I just don’t see any value as a screening test.”

A reliable smell test offers many potential benefits. It could catch far more cases than fever checks, which have largely flopped as screening tools for Covid-19. Studies have found that about 50 to 90 percent of people who test positive for the coronavirus experience some degree of measurable smell loss, a result of the virus wreaking havoc when it invades cells in the airway.

“It’s really like a function of the virus being in the nose at this exact moment,” said Danielle Reed, the associate director of the Monell Chemical Senses Center in Philadelphia. “It complements so much of the information you get from other tests.” Last month, Dr. Reed and her colleagues at Monell posted a study, which has not yet been published in a scientific journal, describing a rapid smell test that might be able to screen for Covid-19.

In contrast, only a minority of people with Covid-19 end up spiking a temperature. Fevers also tend to be fleeting, while anosmia can linger for many days.

A coronavirus testing site in Los Angeles. Smell tests, unlike P.C.R. and antigen tests, would not diagnose the disease nor look for the virus directly.
A coronavirus testing site in Los Angeles. Smell tests, unlike P.C.R. and antigen tests, would not diagnose the disease nor look for the virus directly.Credit…Kendrick Brinson for The New York Times

A smell test could also come with an appealingly low price tag, perhaps as low as 50 cents per card, said Derek Toomre, a cell biologist at Yale University and an author on Dr. Larremore’s paper. Dr. Toomre hopes that his version will fit the bill. The test, the U-Smell-It test, is a small smorgasbord of scratch-and-sniff scents arrayed on paper cards. People taking the test pick away at wells of smells, inhale and punch their guess into a smartphone app, shooting to correctly guess at least three of the five odors. Different cards contain different combinations of scents, so there is no answer key to memorize.

He estimated that the test could be taken in less than a minute. It is also a manufacturer’s dream, he said: A single printer “could produce 50 million of these tests per day.” Numbers like that, he argued, could make an enormous dent in a country hampered by widespread lack of access to tests that look directly for pieces of the coronavirus.

In their study, Dr. Larremore, Dr. Toomre and their collaborator Roy Parker, a biochemist at the University of Colorado, Boulder, modeled such a scenario using computational tools. Administered daily or almost daily, a smell screen that caught at least 50 percent of new infections was able to quash outbreaks nearly as well as a more accurate, slower laboratory test given just once a week.

Such tests, Dr. Larremore said, could work as a point-of-entry screen on college campuses or in offices, perhaps in combination with a rapid virus test. There might even be a place for them in the home, if researchers can find a way to minimize misuse.

“I think this is spot on,” said Dr. Carol Yan, an ear, nose and throat specialist at the University of California, San Diego. “Testing people repeatedly is going to be a valuable portion of this.”

Dr. Toomre is now seeking an emergency use authorization for the U-Smell-It from the Food and Drug Administration, and has partnered with a number of groups in Europe and elsewhere to trial the test under real-world conditions.

Translating theory into practice, however, will come with many challenges. Smell tests that can reliably identify people who have the coronavirus, while excluding people who are sick with something else, are not yet widely available. (Dr. Hopkins pointed to a couple of smell tests, developed before the pandemic, that cost about $30 each and remain in limited supply.) Should they ever be rolled out in bulk, they would inevitably miss some infected people and, unlike tests that look for the actual virus, could never diagnose disease on their own.

And smell loss, like fever, is not exclusive to Covid-19. Other infections can blunt a person’s sense of smell. So can allergies, nasal congestion from the common cold, or simply the process of aging. About 80 percent of people over the age of 75 have some degree of smell loss. Some people are born anosmic.

Moreover, in many cases of Covid-19, smell loss can linger long after the virus is gone and people are no longer contagious — a complication that could land some people in a post-Covid purgatory if they are forced to rely on smell screens to resume activity, Dr. Yan said.

There are also many ways to design a smell-based screen. Odors linked to foods that are popular in some countries but not others, such as bubble gum or licorice, might skew test results for some individuals. People who have grown up in highly urban areas might not readily recognize scents from nature, like pine or fresh-cut grass.

Smell also is not a binary sense, strictly on or off. Dr. Reed advocated a step in which test takers rate the intensity of a test’s odors — an acknowledgment that the coronavirus can drastically reduce the sense of smell but not eliminate it.

But the more complicated the test, the more difficult it would be to manufacture and deploy speedily. And no test, even a perfectly designed one, would function with 100 percent accuracy.

Dr. Ameet Kini, a pathologist at Loyola University Medical Center, pointed out that smell tests would also not be free of the problems associated with other types of tests, such as poor compliance or a refusal to isolate.

Smell screens are “probably better than nothing,” Dr. Kini said. “But no test is going to stop the pandemic in its tracks unless it’s combined with other measures.”

Could a Small Test Screen People for Covid-19?

Could a Smell Test Screen People for Covid?

A new modeling study hints that odor-based screens could quash outbreaks. But some experts are skeptical it would work in the real world.

A health worker in Altos de San Lorenzo, a neighborhood outside Buenos Aires, Argentina, administered a smell test last year.
A health worker in Altos de San Lorenzo, a neighborhood outside Buenos Aires, Argentina, administered a smell test last year.Credit…Alejandro Pagni/Agence France-Presse — Getty Images
Katherine J. Wu

  • Jan. 19, 2021, 5:49 p.m. ET

In a perfect world, the entrance to every office, restaurant and school would offer a coronavirus test — one with absolute accuracy, and able to instantly determine who was virus-free and safe to admit and who, positively infected, should be turned away.

That reality does not exist. But as the nation struggles to regain a semblance of normal life amid the uncontrolled spread of the virus, some scientists think that a quick test consisting of little more than a stinky strip of paper might at least get us close.

The test does not look for the virus itself, nor can it diagnose disease. Rather, it screens for one of Covid-19’s trademark signs: the loss of the sense of smell. Since last spring, many researchers have come to recognize the symptom, which is also known as anosmia, as one of the best indicators of an ongoing coronavirus infection, capable of identifying even people who don’t otherwise feel sick.

A smell test cannot flag people who contract the coronavirus and never develop any symptoms at all. But in a study that has not yet been published in a scientific journal, a mathematical model showed that sniff-based tests, if administered sufficiently widely and frequently, might detect enough cases to substantially drive transmission down.

Daniel Larremore, an epidemiologist at the University of Colorado, Boulder, and the study’s lead author, stressed that his team’s work was still purely theoretical. Although some smell tests are already in use in clinical and research settings, the products tend to be expensive and laborious to use and are not widely available. And in the context of the pandemic, there is not yet real-world data to support the effectiveness of smell tests as a frequent screen for the coronavirus. Given the many testing woes that have stymied pandemic control efforts so far, some experts have been doubtful that smell tests could be distributed widely enough, or made sufficiently cheat-proof, to reduce the spread of infection.

“I have been intimately involved in pushing to get loss of smell recognized as a symptom of Covid from the beginning,” said Dr. Claire Hopkins, an ear, nose and throat surgeon at Guy’s and St. Thomas’ Hospitals in the United Kingdom and an author of a recent commentary on the subject in The Lancet. “But I just don’t see any value as a screening test.”

A reliable smell test offers many potential benefits. It could catch far more cases than fever checks, which have largely flopped as screening tools for Covid-19. Studies have found that about 50 to 90 percent of people who test positive for the coronavirus experience some degree of measurable smell loss, a result of the virus wreaking havoc when it invades cells in the airway.

“It’s really like a function of the virus being in the nose at this exact moment,” said Danielle Reed, the associate director of the Monell Chemical Senses Center in Philadelphia. “It complements so much of the information you get from other tests.” Last month, Dr. Reed and her colleagues at Monell posted a study, which has not yet been published in a scientific journal, describing a rapid smell test that might be able to screen for Covid-19.

In contrast, only a minority of people with Covid-19 end up spiking a temperature. Fevers also tend to be fleeting, while anosmia can linger for many days.

A coronavirus testing site in Los Angeles. Smell tests, unlike P.C.R. and antigen tests, would not diagnose the disease nor look for the virus directly.
A coronavirus testing site in Los Angeles. Smell tests, unlike P.C.R. and antigen tests, would not diagnose the disease nor look for the virus directly.Credit…Kendrick Brinson for The New York Times

A smell test could also come with an appealingly low price tag, perhaps as low as 50 cents per card, said Derek Toomre, a cell biologist at Yale University and an author on Dr. Larremore’s paper. Dr. Toomre hopes that his version will fit the bill. The test, the U-Smell-It test, is a small smorgasbord of scratch-and-sniff scents arrayed on paper cards. People taking the test pick away at wells of smells, inhale and punch their guess into a smartphone app, shooting to correctly guess at least three of the five odors. Different cards contain different combinations of scents, so there is no answer key to memorize.

He estimated that the test could be taken in less than a minute. It is also a manufacturer’s dream, he said: A single printer “could produce 50 million of these tests per day.” Numbers like that, he argued, could make an enormous dent in a country hampered by widespread lack of access to tests that look directly for pieces of the coronavirus.

In their study, Dr. Larremore, Dr. Toomre and their collaborator Roy Parker, a biochemist at the University of Colorado, Boulder, modeled such a scenario using computational tools. Administered daily or almost daily, a smell screen that caught at least 50 percent of new infections was able to quash outbreaks nearly as well as a more accurate, slower laboratory test given just once a week.

Such tests, Dr. Larremore said, could work as a point-of-entry screen on college campuses or in offices, perhaps in combination with a rapid virus test. There might even be a place for them in the home, if researchers can find a way to minimize misuse.

“I think this is spot on,” said Dr. Carol Yan, an ear, nose and throat specialist at the University of California, San Diego. “Testing people repeatedly is going to be a valuable portion of this.”

Dr. Toomre is now seeking an emergency use authorization for the U-Smell-It from the Food and Drug Administration, and has partnered with a number of groups in Europe and elsewhere to trial the test under real-world conditions.

Translating theory into practice, however, will come with many challenges. Smell tests that can reliably identify people who have the coronavirus, while excluding people who are sick with something else, are not yet widely available. (Dr. Hopkins pointed to a couple of smell tests, developed before the pandemic, that cost about $30 each and remain in limited supply.) Should they ever be rolled out in bulk, they would inevitably miss some infected people and, unlike tests that look for the actual virus, could never diagnose disease on their own.

And smell loss, like fever, is not exclusive to Covid-19. Other infections can blunt a person’s sense of smell. So can allergies, nasal congestion from the common cold, or simply the process of aging. About 80 percent of people over the age of 75 have some degree of smell loss. Some people are born anosmic.

Moreover, in many cases of Covid-19, smell loss can linger long after the virus is gone and people are no longer contagious — a complication that could land some people in a post-Covid purgatory if they are forced to rely on smell screens to resume activity, Dr. Yan said.

There are also many ways to design a smell-based screen. Odors linked to foods that are popular in some countries but not others, such as bubble gum or licorice, might skew test results for some individuals. People who have grown up in highly urban areas might not readily recognize scents from nature, like pine or fresh-cut grass.

Smell also is not a binary sense, strictly on or off. Dr. Reed advocated a step in which test takers rate the intensity of a test’s odors — an acknowledgment that the coronavirus can drastically reduce the sense of smell but not eliminate it.

But the more complicated the test, the more difficult it would be to manufacture and deploy speedily. And no test, even a perfectly designed one, would function with 100 percent accuracy.

Dr. Ameet Kini, a pathologist at Loyola University Medical Center, pointed out that smell tests would also not be free of the problems associated with other types of tests, such as poor compliance or a refusal to isolate.

Smell screens are “probably better than nothing,” Dr. Kini said. “But no test is going to stop the pandemic in its tracks unless it’s combined with other measures.”

To Create a Healthy Habit, Find an Accountability Buddy

Well Challenge Day 6

To Create a Healthy Habit, Find an Accountability Buddy

Whether it’s a person or an app that sends us reminders, we make better choices when we’re being watched (even by ourselves.)

Credit…Andrew B Myers
Tara Parker-Pope

  • Jan. 8, 2021, 5:00 a.m. ET

If you want to make positive changes in your life, try building on a lesson many of us learned in 2020: Hold yourself accountable.

The notion of accountability — to yourself and to others — has been an important part of pandemic living. To avoid spreading the virus, we’ve needed to be accountable for wearing a mask, limiting our contacts and keeping our distance.

But accountability can also help you achieve your health goals. Gretchen Rubin, author of “Better Than Before,” a book about forming healthy habits, says that accountability is an important tool for making and breaking habits.

Accountability works best when it comes from the outside. You can create accountability by checking in with a friend every day to talk about healthful eating. You’re more likely to exercise if you’ve made a plan to walk with a friend or scheduled a workout with a personal trainer. You can create public accountability by declaring your intention on social media.

If you prefer to stay accountable only to yourself, you can create accountability by using an app that sends you daily reminders or by wearing a Fitbit or smart watch to track your exercise habits. You can even hold yourself accountable through a daily journal entry.

“We do better when someone’s watching,” Ms. Rubin said. “Even when we’re the ones doing the watching!”

A 2018 North Carolina State University study of 704 people enrolled in a 15-week online weight-loss program found that participants with buddies lost more weight and waist inches than those who took the course without buddy support.

So for today’s Well challenge, think about a health goal you want to achieve and focus on how you can hold yourself accountable. I’ve included a few suggestions for how to do it. Sign up for the Well newsletter to get the 7-Day Well Challenge in your inbox.

Day 6

Create an Accountability Plan

What is your goal for 2021? Do you want to improve your eating habits, lose weight or exercise more? Or maybe you just want to finish that screenplay you’ve been working on? You’re more likely to succeed if you get some help.

Find an accountability buddy. Choose a friend who wants to achieve a similar goal and make a plan. Accountability might mean meeting each other once or twice a week for a walking date. Or it could be a daily text check-in to see how you’re doing on a diet or a Zoom call to work on a decluttering project together.

“Some people are very accountable to themselves, but not most people,” said Dr. Tim Church, a well-known exercise and obesity expert and chief medical officer for Naturally Slim, an app-based behavioral health program in Dallas. “In my years of working with thousands of people, there’s one thing that drives accountability more than anything else: If you want to keep people doing a behavior, get a buddy.”

While the presence of an accountability buddy adds some gentle peer pressure, the key is to focus on the behavior, not success or failure. For instance, if a person is trying to lose weight, don’t focus on the scale. Instead, check in and remind them to log what they ate, encourage them to eat more fruits and vegetables and remind them of the benefits of a regular weigh-in (but you don’t need to ask them the result). If they’re beating themselves up for eating two desserts, talk about what might have triggered an emotional eating binge.

“An accountability partner is there to support you, to problem-solve and to celebrate even the small victories,” Dr. Church said. “Judgment is the quickest way to destroy all that. People are so hard on themselves. You don’t need to be hard on them.”

Use an app. An app is a great way to add accountability to your day. Meditation apps like Headspace and Calm will send daily reminders and track your progress. The weight-loss app Noom asks you to check in for a few minutes each day, complete mini-health courses and track what you’ve eaten. The Fitbit app counts your steps, will sync with your smart scale and vibrates to remind you to get up and move.

Set reminders. Once you set a health goal, hold yourself accountable by creating calendar reminders to help you achieve it. Schedule walk breaks or daily or weekly check-ins with your accountability buddy.

Declare it on social media. Telling your friends on social media that you’re cutting back on packaged foods, or sending a tweet every time you finish a class on your exercise bike creates virtual accountability. Commit to posting on Facebook, Instagram, Twitter or another platform every time you complete a goal, or share your feelings on days you’re struggling. When you declare your goals on social media, you’re likely to find a like-minded friend who will want to join your journey and offer words of support.

Family Geocaching

Take Your Family on a Treasure Hunt With Geocaching

A game of hide-and-seek using GPS technology is a joyful distraction for many.

Credit…Ka Young Lee

  • Jan. 2, 2021, 11:43 p.m. ET

If it feels as if you’ve already explored every last nook and cranny of your cramped lockdown life know this: Right under your nose, there’s a hidden world operating entirely out of view.

That world is geocaching, a no-contact game of hide-and-seek between hundreds of thousands of strangers. Players hide caches — waterproof containers, usually small plastic boxes — in out-of-sight spots for others to discover using GPS technology.

How has this world remained totally hidden from you? The first rule of geocaching is to try to keep your searching a secret. If a runner jogs by, players may pretend to be deeply engrossed in plant identification. (Once you know about geocaching, you may realize just how many other folks are pretending to be fascinated by that patch of ivy.)

Geocaching began in earnest in 2000, when the U.S. military adjusted its GPS satellites to improve accuracy for recreational GPS users. An enthusiast in Oregon hid the first cache, said Bryan Roth, president and co-founder of Geocaching HQ, which runs Geocaching.com. Since then, the community has grown steadily, with the pandemic spurring a considerable increase in participation.

“At a time when people are looking for some distraction, getting outside really works well,” said Mr. Roth, who noted that sign-ups for the Geocaching app are up 70 percent compared with last year.

To get started, download an app on your phone, like Geocaching HQ (free download and some free caches, but the $30 annual membership unlocks more); Cachly ($4.99 and free caches, iPhone only); or c:geo (free download and free caches, Android only). You can also geocache with a hand-held GPS device, using online databases like NaviCache.com to find cache coordinates.

Caches are rated 1 to 5 by their difficulty; beginners may want to start with a 1 and work up from there. GPS will usually get you within 30 feet of the cache, and instructions like “look to the north of the roadway” can clue you in on exactly where you should be searching.

Then the real hunt begins.

When you find the cache — be it hidden under a tree, tucked into a log pile or taped to the back of a sign — you can check it off on the app. Most caches have a logbook tucked inside which shows everyone who was there before you, while others will contain a trinket as a treasure. (Putting a few tiny objects in your pocket before you head out gives you options if you think you might want to swap with the trinkets inside.)

One particularly nice benefit of geocaching is that it gets screen-addicted kids outside. And even though geocaching happens outdoors, you needn’t be outdoorsy.

When a friend first suggested that Katie Sweeney and her husband try geocaching in 2007, “I was like, I don’t really like hiking,” she remembered. Ms. Sweeney, a copywriter based in the Netherlands, soon found many caches within a few blocks of her home, in Philadelphia at the time. Today, she takes her 6-year-old daughter out to geocache on their way to or from the grocery store or other errands.

“We’re always discovering new places near where we live,” Ms. Sweeney said, adding that children can really be an asset. Their different vantage points often helps them see things adults might overlook.

Nick Geidner, a University of Tennessee journalism professor, doesn’t mind if a hunt is a bust.

“We don’t always find them,” he said. “But if we fail, we can come back and we can try again.” Henry, his 7-year-old son, wasn’t quite so sure. When asked how he felt after giving up on a recent hunt, he said, “I’m not like angry, but I’m not like happy.”

The thrill of finding a tricky or unique cache, though, far outweighs those not-happy moments. In September, Ms. Sweeney and her daughter found a once-in-a-lifetime cache, which had a gamelike opening with a maze, magnetic ball and secret code.

“It was this little joy,” said Ms. Sweeney, recalling opening the cache. “We’re all just looking for little moments of joy.”

Winter Exercise Guides and Apps

To Keep Moving, Download Some Ambition

If you need a dose of exercise inspiration, it’s easy to find online or on your phone with these guides and apps.

The Zwift app features “live” rides in which you can join athletes from all over the world.
The Zwift app features “live” rides in which you can join athletes from all over the world.

  • Jan. 2, 2021, 10:24 p.m. ET

It’s a hibernation season like no other: It’s colder and darker, and you’re still inside. Which makes it all the more important (and all the harder) to keep yourself moving. As 2021 begins, here are some ideas to get you out of the house, or at least off the couch for a bit.

Running Audio Guides

A massive running boom began in the spring as many people returned to the simplest exercise: one foot in front of the other until you’ve spent an adequate amount of time away from your seemingly shrinking home.

If you need a new boost to get back outside, or back on the treadmill, try an app like Nike Run Club or Asics Studio that offers free, guided runs. These are usually accompanied by music and a coach supplying instruction and motivation. Both apps have runs for beginners and more advanced runners looking for speed workouts or intervals. A little extra motivation can go a long way.

Indoor Biking Apps

Miss biking outdoors and not looking to buy a stationary bike? You can purchase bike rollers or an indoor bike trainer, allowing you to safely ride your outdoor bike indoors. Add an app to make things more entertaining than starting at your living room wall. Rouvy has virtual routes and challenges like riding the Ironman Australia route, complete with elevation maps and video from the course. You can also join a virtual world and ride with Zwift, with “live” rides in which you can join athletes from across the globe. Rouvy charges $12 per month, while Zwift costs $14.99 per month.

Yoga With Adriene

If you are looking for a no-frills yoga class that feels like it’s tailored to you, look no further than Yoga with Adriene, from Adriene Mishler, who The New York Times Magazine called “the reigning queen of pandemic yoga.” On YouTube, Mishler has created free yoga for writers and yoga for chefs, yoga for runners and yoga for travelers, yoga for equestrians and yoga for surfers, and a recent video titled “Yoga for When You Feel Dead Inside.” She also has 30-day yoga “journeys.”

Peloton — With or Without Equipment

Sure, you’ve heard of Peloton’s bike and treadmill. But the company also has a slate of classes and programs on its app for those looking to stay in shape at home without a big investment in hardware. You can sort through strength programs for those that require specific equipment (classes that use resistance bands, for example) or choose ones that don’t require any equipment whatsoever. The app offers a $12.99 monthly digital membership.

Peloton is one of the largest and most-established players in the at-home fitness industry, and its teachers understand the challenges of working out wherever you can find the space. It’s not uncommon to hear an instructor remind participants to find a spot where they can stretch their arms out safely, without knocking anything (or anyone) over.

Boutique Classes

Miss being able to sample boutique fitness classes? The Obé Fitness app has numerous classes available on demand, but one of its greatest strengths is the diversity of live classes. The classes, taught by many instructors recognized by devotees of New York City’s boutique fitness scene, are filmed in pastel studios that resemble squares of an Instagram page. On any given day, there’s some combination of Pilates classes and dance classes, cardio boxing, yoga sculpt, barre and strength. There app offers both annual subscriptions ($199) and monthly ones ($29.99).

Have a Workout Type in Mind? Turn to YouTube

If you have an idea of what you are looking for — be it a 10-minute core workout, a 15-minute prenatal stretching routine or a 30 minute body-weight class — many of your best options can be found for free on YouTube. The hard part is sorting through the embarrassment of riches, so be prepared to find thousands of results that could prove effective.

Amazon Halo Review: The Fitness Gadget We Don’t Deserve or Need

tech fix

Amazon Halo Review: The Fitness Gadget We Don’t Deserve or Need

The retail giant claims that its health product is extremely precise at scanning body fat. I found otherwise.

Credit…Glenn Harvey
Brian X. Chen

By

  • Dec. 9, 2020, 5:00 a.m. ET

Many of us are in the same boat these days. With the coronavirus killing more people by the day, we are increasingly stress-eating and drinking more alcohol. At the same time, with gyms shut down, we are sitting around more and glued to screens.

So you may be wondering what I’m wondering: How is the pandemic affecting my body? Because we can’t easily leave the house to see doctors for nonemergencies, we are largely left to figure this out on our own.

Enter the Halo, a new fitness-tracking bracelet from Amazon with a novel twist: It claims that by using a smartphone app to scan images of your body, it can tell you how much body fat you have much more precisely than past technologies. The bracelet also has a microphone to listen to your tone of voice and tell you how your mood sounds to other people. (The masochist inside me said, “Sign me up!”)

The Halo is Amazon’s foray into so-called wearable computers that keep an eye on our health, following in the footsteps of Apple and Fitbit. Amazon is selling the Halo for $65 on an invitation-only basis, meaning you have to get on a waiting list to buy it. I volunteered to be a guinea pig and received mine in October.

When the Halo arrived, I installed the app, removed my T-shirt and propped up my phone camera. Here’s what happened next: The Halo said I was fatter than I thought — with 25 percent body fat, which the app said was “too high.”

I was skeptical. I’m a relatively slim person who has put on two pounds since last year. I usually cook healthy meals and do light exercises outdoors. My clothes still fit.

I felt body-shamed and confused by the Halo. So I sent my Halo data and body scans to Dr. Lawrence Cheskin, a professor of nutrition and food studies at George Mason University and founder of the Johns Hopkins Weight Management Center.

After reviewing my results, Dr. Cheskin jotted down my height and weight to calculate my body mass index, which is a metric used to estimate obesity. A man my age (36) with my body mass index, he said, is highly unlikely to have 25 percent body fat.

“Unless you were a couch potato and ate a very poor diet, I have my doubts about the Halo’s diagnosis,” he said.

Dr. Cheskin encouraged me to gather more data by measuring my body fat with other devices, and to do the same with at least one other person. So I did and found that the Halo’s body fat readings consistently skewed higher than other tools for myself and my test subject.

I concluded that the Halo’s body analysis was questionable. More important, it felt like a negative experience that failed to motivate me to get fit. I’ve had much more uplifting experiences with other products like the Apple Watch and Fitbit bands, as laid out below.

Measuring Body Fat

The Amazon Halo bracelet and app.
The Amazon Halo bracelet and app.Credit…Amazon

Body fat measurement can be complicated because the traditional methods available to consumers are not always accurate.

Smart bathroom scales that measure body fat use bioelectrical impedance analysis, which sends a small current through your bare feet. Skin calipers, a more dated method, are essentially rulers that pinch down on skin folds to measure thickness.

These techniques are not perfectly reliable. If people step on smart scales at different times of day or with different levels of hydration, their results may vary. Calipers can measure skin folds incorrectly if you pinch in the wrong areas.

Amazon said the Halo’s technology was much more precise. To scan your body, you use the smartphone’s front-facing camera to take photos of your body from the front, sides and rear. Then Amazon stitches the images together into a 3-D model to analyze your body composition and calculate the percentage of fat.

I decided to record consistent body fat measurements for myself and a friend using the Halo, a Fitbit bathroom scale and a highly rated skin caliper. In November and December, I took early-morning measurements with the Halo and bathroom scale; my wife pinched my skin folds in four areas with the caliper. I measured my test subject’s body fat once with each device.

Our results were remarkably similar for two men with very different body compositions:

  • The Amazon product estimated that my friend, a 6-foot-3 man weighing 198 pounds, had 24 percent body fat, the Fitbit scale read 19 percent, and the skin-fold measurements added up to 20 percent.

  • For myself — 5-foot-6 and about 140 pounds — the Halo said in November that I had 25 percent body fat, the Fitbit scale said 19 percent, and the skin-fold measurements added up to 20 percent. In December, the Halo said I had 26 percent body fat (alas, I had more Thanksgiving leftovers than usual), the Fitbit scale said 20 percent, and the skin-fold measurements added up to 21 percent.

Dr. Cheskin speculated that the Halo might have an overestimating bias in its algorithm because underestimating body fat for an obese person would be more problematic.

Dr. Maulik Majmudar, Amazon’s medical officer, who worked on the Halo, said people should expect the device’s results to be different because the method was more accurate than body fat scales and calipers.

Amazon developed its body-measuring algorithm from a sample set of tens of thousands of images of people’s bodies from across a wide range of demographics, he said. Amazon then did internal tests measuring people’s body fat using the Halo scanner, smart bathroom scales and DEXA, a technique that uses X-rays to scan for bone density, which studies have found to be a reliable measure for body fat. It found that the Halo method was twice as accurate as bathroom scales.

Still, Dr. Cheskin was unconvinced by Amazon’s accuracy claims. He said a valid study would involve a clinical trial measuring body fat of many human subjects with each method — the Halo, DEXA, bioelectrical impedance scales and calipers — and comparing the results side by side.

Accurate or not, the most disappointing part of Amazon’s body fat analysis was that it lacked important context. Even though the app asked for my ethnicity, age and sex, it said my 25 percent body fat level was too high and well outside the “Healthy” zone (roughly 12 to 18 percent). It also said healthy results were associated with longer life and lower risks of heart disease.

Dr. Cheskin offered a more nuanced analysis. Body fat levels may have different health implications depending on your age, ethnicity, sex, cholesterol levels and family history. Waist circumference matters, too, because severe abdominal fat can be associated with health problems.

For an Asian man my age with a 34-inch waistline, whose family has not had a history of diabetes or heart problems, and whose blood tests recently showed normal cholesterol levels, even a 25 percent body fat reading would probably not be alarming, he said.

That context, combined with my body mass index along with the measurements taken with a body fat scale and caliper, led Dr. Cheskin to doubt Halo’s analysis.

He worried about the technology’s potential consequences.

“Does it potentially create eating disorders?” he said. “You’re taking a bunch of people with normal weight and B.M.I. and telling them they’re too fatty. What are they going to do with that? Some of them are going to be more compulsive and start doing things that are going to be inappropriate.”

Bottom Line

This experiment raised another question: What in the world was Amazon thinking releasing a product like this now? It has been impossible for us to move around as much as we used to this year. If anything, we should accept that our bodies will be imperfect during this time.

Dr. Majmudar said he felt the opposite. As a clinician, he said, he would encourage patients to mitigate the health risks of gaining weight and being more sedentary in the pandemic. The goal of the Halo was to drive behavioral change with education and awareness, he said.

“The desire or intention was never to body-shame people,” he added.

In my experience, there are better fitness-tracking products that offer more positive motivation.

The Apple Watch, for one, lets you set goals for how much you want to move or exercise each day, and those goals are symbolized by colorful rings that are shown on the watch face. Once a ring is completed, you have met your goal. Fitbit devices send notifications to your phone, egging you on when you are nearing your step goal. Neither device comes anywhere close to giving you body dysmorphia.

Another of Halo’s unique features is Tone, which uses the bracelet’s microphone to periodically eavesdrop on your conversations to tell you what your mood sounds like. I turned the feature off after two days because it felt like a creepy invasion of privacy. But I left it on long enough to complain to my wife about what a bad idea it was.

After analyzing the conversation, the Halo app said I sounded irritated and disgusted. That, at least, was accurate.

It’s Time for a Digital Detox. (You Know You Need It.)

When is enough enough?

Even though the presidential election is over, we’re still doomscrolling through gloomy news about the coronavirus surge. The rest of your daily routine is probably something like mine while stuck at home in the pandemic: Divided among streaming movies on Netflix, watching home improvement videos on YouTube and playing video games. All of these activities involve staring at a screen.

There has to be more to life than this. With the holiday season upon us, now is a good time to take a breather and consider a digital detox.

No, that doesn’t mean quitting the internet cold turkey. No one would expect that from us right now. Think of it as going on a diet and replacing bad habits with healthier ones to give our weary eyes some much needed downtime from tech.

“There’s lots of great things to do online, but moderation is often the best rule for life, and it’s no different when it comes to screens,” said Jean Twenge, a psychology professor at San Diego State University and the author of “iGen,” a book about younger generations growing up in the smartphone era.

Too much screen time can take a toll on our mental health, depriving us of sleep and more productive tasks, experts said. I, for one, am experiencing this. Before the pandemic, my average daily screen time on my phone was three and a half hours. Over the last eight months, that has nearly doubled.

So I turned to psychology experts for their advice. From setting limits to finding alternatives to being glued to our phones, here’s what we can do.

Come Up With a Plan

Not all screen time is bad — after all, many students are attending school via videoconferencing apps. So Step One is assessing which parts of screen time feel toxic and make you unhappy. That could be reading the news or scrolling through Twitter and Facebook. Step Two is creating a realistic plan to minimize consumption of the bad stuff.

You could set modest goals, such as a time limit of 20 minutes a day for reading news on weekends. If that feels doable, shorten the time limit and make it a daily goal. Repetition will help you form new habits.

That’s easier said than done. Adam Gazzaley, a neuroscientist and co-author of the book “The Distracted Mind: Ancient Brains in a High-Tech World,” recommended creating calendar events for just about everything, including browsing the web and taking breaks. This helps create structure.

For example, you could block off 8 a.m. to read the news for 10 minutes, and 20 minutes from 1 p.m. for riding the exercise bike. If you feel tempted to pick up your phone during your exercise break, you would be aware that any screen time would be violating the time you dedicated to exercise.

Most important, treat screen time as if it were a piece of candy that you occasionally allow yourself to indulge. Don’t think of it as taking a break as that may do the opposite of relaxing you.

“Not all breaks are created equal,” Dr. Gazzaley said. “If you take a break and go into social media or a news program, it can get hard to get out of that rabbit hole.”

Create No-Phone Zones

We need to recharge our phones overnight, but that doesn’t mean the devices need to be next to us while we sleep. Many studies have shown that people who keep phones in their bedrooms sleep more poorly, according to Dr. Twenge.

Smartphones are harmful to our slumber in many ways. The blue light from screens can trick our brains into thinking it’s daytime, and some content we consume — especially news — can be psychologically stimulating and keep us awake. So it’s best not to look at phones within an hour before bed. What’s more, the phone’s proximity could tempt you to wake up and check it in the middle of the night.

“My No. 1 piece of advice is no phones in the bedroom overnight — this is for adults and teens,” Dr. Twenge said. “Have a charging station outside the bedroom.”

Outside of our bedrooms, we can create other No-Phone Zones. The dinner table, for example, is a prime opportunity for families to agree to put phones away for at least 30 minutes and reconnect.

Resist the Hooks

Tech products have designed many mechanisms to keep us glued to our screens. Facebook and Twitter, for example, made their timelines so that you could scroll endlessly through updates, maximizing the amount of time you spend on their sites.

Adam Alter, a marketing professor at New York University’s Stern School of Business and author of the book “Irresistible: The Rise of Addictive Technology and the Business of Keeping Us Hooked,” said that tech companies employed techniques in behavioral psychology that make us addicted to their products.

He highlighted two major hooks:

  • Artificial goals. Similar to video games, social media sites create goals to keep users engaged. Those include the number of likes and followers we accrue on Facebook or Twitter. The problem? The goals are never fulfilled.

  • Friction-free media. YouTube automatically plays the next recommended video, not to mention the never-ending Facebook and Twitter scrolling. “Before there was a natural end to every experience,” like reading the last page of a book, he said. “One of the biggest things tech companies have done was to remove stopping cues.”

What to do? For starters, we can resist the hooks by making our phones less intrusive. Turn off notifications for all apps except those that are essential for work and keeping in touch with people you care about. If you feel strongly addicted, take an extreme measure and turn the phone to grayscale mode, Dr. Alter said.

There’s also a simpler exercise. We can remind ourselves that outside of work, a lot of what we do online doesn’t matter, and it’s time that can be better spent elsewhere.

“The difference between getting 10 likes and 20 likes, it’s all just meaningless,” Dr. Alter said.

An App to Deconstruct Your Food

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A screenshot of the Sage app.

A screenshot of the Sage app.Credit

Ever wondered how long you’d have to swim to burn off the calories in an organic peanut butter cup? Or how far the strawberries or burger on your plate traveled to get there?

For answers, ask the Sage Project, one of the latest of the food technology companies helping consumers navigate nutrition. While a number of food apps count calories and track eating habits, Sage goes beyond the food label to give customers additional information about additives and preservatives, how much sugar has been adding during processing or how far a food has traveled.

“Food labels are a data visualization that we see every day, but we don’t get a lot from them,” said Sam Slover, the co-founder and chief executive of Sage. “There are a lot of things about those labels that make assumptions about what you know and what you want to know.”

Do we really need another food app? Apple’s app store already lists more than three dozen apps offering users information and advice about calories, nutrition data and weight loss, but research shows that many consumers have a failed relationship with their food apps. For instance, in January, about 16 percent of the people who downloaded the Lose It app were using it once a day. By June, only 10 percent were using it that often, according to research firm 7Park Data.

“These apps have trouble keeping customers loyal — if you use them successfully, you don’t need them any more, and if you don’t use them successfully, you may not think it’s worth it to try more,” said Byrne Hobart, the lead analyst at 7Park Data. “They’re kind of like the dating apps that way.”

The Sage app hopes to inspire more loyalty by providing a trove of useful and quirky information about the food you eat. It contains data on about 20,000 products, though you still may not find your favorite junk foods. Most of the products in the database are described as “natural” and “organic.” But if you shop at Whole Foods, you’re in luck. Sage has partnered with Whole Foods Market, deconstructing all of the roughly 7,000 items sold in the grocer’s new “365” store chains in Los Angeles and Lake Oswego, Ore.

To begin using Sage, which is available online or as a web-based app, a user signs up and enters any food restrictions and personal preferences. Only want to see products without additives and preservatives? No problem. Interested in digestive health? Sage will comb through its database and show you products with probiotics, high fiber and whole grains.

The app displays a wide variety of information using colorful graphics and animated food characters, and it’s surprisingly fun and entertaining to use. The app told me that Surf Sweet gummy bears, for instance, do have a fair amount of added sugar but also have “good nutrient density,” meaning that, among other things, they supply a high amount of vitamin C (much to my delight). A jump-roping chocolate bar informs me that I’d need to jump rope for 19 minutes — or a snorkeling olive recommends 23 minutes of swimming — to burn off a serving of Justin’s Organic milk chocolate peanut butter cups.

“Customers want a better understanding of how a product is sourced, the quality standards behind it, whether the labor that made it was paid a fair wage, its impact on the environment,” said Jason Buechel, the chief information officer at Whole Foods. “This is a way to give them all that information that isn’t captured on the nutrition label.”

Take the Beast Burger, for instance, a meatless burger sold at Whole Foods. Type the name of the burger into Sage or flip through a list, and you’ll find its basic nutritional profile and calorie content, with highlights of its nutritional strengths.

Using animated food characters — a pear doing yoga, a watermelon riding a bike — the app shows how much exercise would be required to work off the burger. In my case, it’s 20 minutes of running, 22 minutes of jumping rope, 28 minutes of swimming or biking, 44 minutes of dance or 89 minutes of yoga.

Sage also identifies any allergens — corn and seeds in the case of the Beast Burger — and offers detailed explanations of all the burger’s ingredients, and why they’re used should you be interested. For instance: “Calcium chloride, a salt, is used in canned goods to improve stability and quality and as a firming agent in tofu production.”

The system awards “badges” to the burger for things like an abundance of healthy fats and protein and having recyclable packaging, and it explains what diets — dairy free, gluten free, vegan, vegetarian and ketogenic — it does not violate. To make nutrition recommendations like “fiber friendly” or “heart healthy,” Sage uses nutritional standards set by the Food and Drug Administration and the American Heart Association. An in-house team of dietitians and nutritionists have created standards for badges like “healthy fats” or “contains probiotics” — areas where the F.D.A. doesn’t set guidelines.

Finally, the app tells you where the product is made or sourced. The Beast Burger is American made. If you decided to check out Driscoll strawberries, you might learn your batch came from Mexico.

It also can tailor daily nutritional requirements to a user’s specific weight, height and lifestyle. For instance, Sage came up with a recommended daily caloric intake of about 3,300 calories that is rich in protein for Mr. Slover, given his height, weight and exercise routine — he’s a triathlete. It recommended a 1,600-calorie diet with a lower portion of protein for his mother.

“All those things on a label telling you that a product gives you, say, 10 percent of the daily requirement of protein is based on a default, 2,000-calorie-day diet, a kind of one-size-fits-all approach that doesn’t work,” Mr. Slover said.

One thing the Sage app won’t tell you is what you should or shouldn’t eat. You will have to figure that out for yourself. “I’m not a big fan of red, yellow and green scoring mechanisms for food,” Mr. Slover said. “I don’t think they’re well received by consumers or used very much.”

10 Children’s Apps for Summer Road Trips

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Credit iStock

The car is packed, the pets have sitters and the GPS is programmed. But have you properly prepped your children’s devices?

While there are many apps that can keep a child busy, the best are those designed to promote active, engaged, meaningful and social learning, researchers say.

Here are some recent apps for the job. Most work without a Wi-Fi tether, are free or very affordable and are rich in bite-size bits of interaction, making them easy to pass around the car. Platform and price information change frequently, so check your favorite app store for the latest information.

FOR YOUNGER CHILDREN (ages 3 to 7)

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Chomp by Christoph Niemann, Fox and Sheep GmbH ($2.99 on iOS, Android), is a powerful, easy-to-use video creativity experience that combines hand-drawn animations with real-time video. You’ll find your face inside 52 spring-loaded gags that you can try out simply by looking into the camera, and swiping. Pass this app around and give everyone a chance — except the driver.

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HangArt: Play Hangman, Draw Pictures, Tell Stories by Literary Safari ($1.99 on iOS, Android) brings the age-old game of hangman to your road trip, using words straight out of a school reading curriculum. The two-player mode can promote cooperative play.

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Heads Up! Kids by Warner Bros. Interactive Entertainment (99 cents with in-app purchases, on iOS and Android) is another fun, social word game that is a simplified version of the Ellen DeGeneres game, in which you hold your device up to your forehead and ask someone else for a clue. The initial download contains six decks of virtual cards on topics like animals; extras cost a dollar each.

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Moonbeeps: Gizmo by Moonbot Studios ($1.99 on iPad, iPhone) turns your tablet into a pretend dashboard full of dials and switches that are perfect for imaginary play, say, for turning your minivan into a submarine.

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Sago Mini Robot Party ($2.99 on iPad, iPhone) contains a set of rubbery robot parts that can be mixed and matched. We like how easy it is to be silly with this app. You can use the sock for a head, for example, or put two heads on the feet and flip the robot upside down.

FOR OLDER CHILDREN (ages 8 and up)

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MSQRD — Live Filters & Face Swap for Video Selfies by Masquerade Technologies (free on iPad, Android) is like sticking your head inside a magical mirror where you can try on some glow-in-the-dark face paint, or do a face swap with the person sitting next to you — and you can post it on Facebook. Keep this one far away from the driver.

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Thinkrolls 2 by Avokiddo ($2.99 on iPad, Android, Kindle) lets you swipe your way through a series of increasingly challenging mazes. This is the second app in the series, and it’s well named because it gently introduces properties of matter and physics. You discover that things do more than “roll.” They can also float, glide and teleport through the 270 levels.

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Stack the States 2 by Freecloud Design ($2.99 on iPad, iPhone) for ages 7 and up is a great app for learning about the United States while you drive through it. The app quizzes you on the capital, shape and location of each state. You can now zoom in for a 3-D view of the details on key cities and landmarks.

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Toca Life: Vacation by Toca Boca ($2.99 on iPad, iPhone) transforms your back seat into a tropical resort, with its own airport, hotel and island. There’s no way to fail with this free-play app, and there’s room for plenty of cooperative play.

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Finding Dory: Just Keep Swimming by Disney ($3.99 on iPad, Android, Kindle) delivers plenty of well-illustrated, slippery fun in this maze game. There are 13 levels, each inspired by the movie, and it’s easy to revisit an already mastered level, so a little brother or sister can have a turn. Make sure children know that they can pause the game at any point.

FOR THE WHOLE FAMILY

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Traveling at night? Turn your vehicle into a rolling planetarium with Star Walk HD ($2.99 for iPad, Android). You’ll be able to predict when and where the moon will come up, or confirm if the bright star is actually Saturn.

Google Maps is a wonderful family resource. You can install a second version on your child’s Android or Apple device, saving on data costs by using the “offline map feature.” As you drive, your child can view the scrolling maps, and help you find landmarks or navigation, dropping pins on favorite places along the way. Show your child how to toggle between satellite, topographic and regular map modes, and use the Street View feature to follow your car.

Finally, Siri loves geography facts. Besides knowing “how many people live in Detroit,” she can tell you current altitude, or where the closest rest area might be. She’ll also have the exact answer, in miles, to that age-old back-seat question, “Are we there yet?”

A Shocking Way (Really) to Break Bad Habits

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Credit Kim Murton

Every January for the past decade, Jessica Irish of Saline, Mich., has made the same New Year’s Resolution: to “cut out late night snacking and lose 30 pounds.” Like millions of Americans, Ms. Irish, 31, usually makes it about two weeks.

But this year is different.

“I’ve already lost 18 pounds,” she said, “and maintained my diet more consistently than ever. Even more amazing — I rarely even think about snacking at night anymore.”

Ms. Irish credits a new wearable device called Pavlok for doing what years of diets, weight-loss programs, expensive gyms and her own willpower could not. Whenever she takes a bite of the foods she wants to avoid, like chocolate or Cheez-Its, she uses the Pavlok to give herself a lightning-quick electric shock.

“Every time I took a bite, I zapped myself,” she said. “I did it five times on the first night, two times on the second night, and by the third day I didn’t have any cravings anymore.”

As the name suggests, the $199 Pavlok, worn on the wrist, uses the classic theory of Pavlovian conditioning to create a negative association with a specific action. Next time you smoke, bite your nails or eat junk food, one tap of the device or a smartphone app will deliver a shock. The zap lasts only a fraction of a second, though the severity of the shock is up to you. It can be set between 50 volts, which feels like a strong vibration, and 450 volts, which feels like getting stung by a bee with a stinger the size of an ice pick. (By comparison, a police Taser typically releases about 50,000 volts.)

Other gadgets and apps dabble in behavioral change by way of aversion therapy, such as the $49 MotivAider that is worn like a pager, or the $99 RE-vibe wristband. Both can be set to vibrate at specific intervals as a reminder of a habit to break or a goal to reach. The $80 Lumo Lift posture coach is a wearable disk that vibrates when you slouch. The $150 Spire clip-on sensor tracks physical activity and state of mind by detecting users’ breathing patterns. If it detects you’re stressed or anxious, it vibrates or sends a notification to your smartphone to take a deep breath.

But the Pavlok takes things a step further, delivering a much stronger message.

To test the device, I wore it for a week, zapping myself every time I ate dessert. My goal was to curb my craving for sweets after dinner. First I zapped myself before and after I ate a square of dark chocolate, and did it again later in the week after eating ice cream, a red velvet cupcake and a chocolate chip cookie.

Set on low, it feels like a strong tickle. Set on high, it hurts. A lot.

It should be noted that the creator of Pavlok, Maneesh Sethi, once hired a woman to sit next to him and slap him on the face every time she saw him using Facebook, so he could increase his productivity. I called Mr. Sethi and told him that if we ever met, I’d try not to punch him in the face for creating such an awful torture device. “Yeah, I get that a lot,” Mr. Sethi said with a chuckle. “People either love it or hate it.”

“It’s not designed to be painful,” he added. “It’s instantaneous, a surprise sensation, a shock that knocks you out of automatic mode.”

But does this kind of self-imposed aversion therapy actually work?

“The most clever thing about this gadget is the name,” said Dr. Peter Whybrow, a Los Angeles author, psychiatrist and neuroscientist. “It’s an expensive spin on the idea of wearing an elastic band that you snap on your wrist to stop a certain behavior.”

Dr. Marc Potenza, a professor of psychiatry at Yale, says researchers have questioned the ethical nature of shock intervention when more comfortable options like cognitive behavioral therapies, pharmaceutical interventions and 12-step programs are available.

The practice of aversion therapy has been around for 80 years. Schick Shadel Hospital, based in Seattle, reports that it has successfully treated more than 65,000 people for alcohol or drug addiction using counter-conditioning methods like emetic drugs, which make people feel nauseated if they drink alcohol, or supervised shock therapy. The hospital’s medical director, Dr. Kalyan Dandala, said that he was interested in using Pavlok to help people continue recovery once they finish the 10-day inpatient treatment, but added that the device should be professionally supervised.

“It’s better suited as a prescribed tool for behavior modification,” Dr. Dandala said. “The company needs to refine it, put more education in the tool, and have more oversight.”

Michelle Freedland, a psychiatric nurse practitioner in Manhattan, has worked with five patients who use the device for nail biting, addictions, compulsive behaviors and more.

“When one of my patients told me he was using it last year to help him get out of bed in the morning, I was skeptical at first,” she said. “I mean, the notion of being shocked — you can have a little reservation. But when you understand how to use it properly and people are more engaged in their own treatment, they tend to follow through with it more.”

Mr. Sethi, the founder, said the company had just begun to collect data on the long-term success of the device, and was planning a clinical trial later this spring. The Pavlok has been available since November, and he said about 10,000 people had used it.

Despite the potential for pain and the lack of science backing a long-term effect, user feedback on Facebook groups and message boards has been enthusiastic about the device, especially as a last resort for problems like overeating and binge drinking.

Bud Hennekes, 24, a blogger in St. Louis, said he had used Pavlok to kick a nearly two-pack-a-day cigarette habit. “When I tried to quit before, I still had the craving to smoke,” he said. “When I used Pavlok, the cravings completely went away. I don’t know if it’s science or a placebo effect or what, and I don’t really care because it worked.”

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Swipe Right to Connect Young People to H.I.V. Testing

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A screenshot of the Healthvana app.

A screenshot of the Healthvana app.Credit

Midway through her sophomore year of high school, my patient told her parents that she had missed two periods and was worried she might be pregnant.

Stunned to learn that she was sexually active, her parents took her to the pediatrician, who had another surprise: She wasn’t pregnant but she did have H.I.V.

I met her a few days later in my H.I.V. clinic, and watched her start crying as I told her that her H.I.V. was advanced and that she needed antiviral treatments really soon.

Sadly, her story of late diagnosis is far from uncommon. Ten thousand people ages 13 to 24 are given H.I.V. diagnoses every year in the United States, and epidemiologists estimate fully half of young people with H.I.V. do not know it. While the virus is no longer considered the death sentence it was decades ago, late diagnoses like my patient’s can undermine the life-saving benefits of antiviral medications, leading to greater risk of AIDS and death.

Part of the problem is the low rate of H.I.V. testing in young people, despite the recommendation by the Centers for Disease Control and Prevention that every sexually active person over the age of 13 get tested. Earlier this year, C.D.C. researchers reported in Pediatrics that pediatricians and parents are testing five times fewer young people for H.I.V. than recommended by national guidelines. Only 22 percent of sexually active high school students were ever tested for H.I.V., and, even worse, the likelihood that young women like my patient were tested for H.I.V. actually fell from 2011 to 2013.

Tio Pier, a Stanford University student who advocates for testing and sexual health education, says his high school teachers provided basic education about H.I.V. in a health class but, “they don’t follow up and say, ‘and if you feel like you need a testing resource you could go here…’ There was none of that.” Indeed, a 2015 survey showed that less than half of sexually active gay and bisexual adolescents even knew where they could get an H.I.V. test.

A number of groups are working on ways to improve access to H.I.V. testing for young people. Tim Kordic, a health educator with the Los Angeles Unified School District, is partnering with a company called Healthvana to place educational posters about H.I.V. in classrooms and provide students with a free iPhone app that harnesses GPS technology to locate nearby H.I.V. testing facilities.

Most public health departments and community health clinics offer free H.I.V. testing to people of all ages, and in New York and 30 other states, children under 18 have legal access to H.I.V. testing without parental notification. Kids who test positive can access life-saving H.I.V. therapy early, with drug costs often covered by the federally funded Ryan White HIV/AIDS Program. Kids who test negative leave the clinic better educated and probably with a pocketful of free condoms.

Ramin Bastani, the chief executive of Healthvana, says their app has delivered the results of over 200,000 H.I.V. and sexually transmitted infection tests to patients at participating health care providers across the country. The confidential service also gives users information on how to access treatment if a result is positive. Some young people post negative H.I.V. testing results on social media as a way of encouraging others to get tested, Mr. Bastani said.

Healthvana isn’t the only app seeking to connect youth to H.I.V. testing. The United States Department of Health and Human Services has its own locator app pointing out nearby testing services and a panoply of other resources like H.I.V. care, substance abuse services and housing assistance. Yet another app connects users to free condoms, and there is even a mobile game designed to sensitize youth to the risks of teenage pregnancy.

“It’s hard for teenagers to physically go places, and to know that they will be welcomed,” says Karen Rayne, a sexuality educator and author of the book “Breaking the Hush Factor: Ten Rules for Talking With Teenagers about Sex.” To Dr. Rayne, the privacy of a mobile app – including the ability to delete the app after use – is a great way to “draw teens out” and “give them the confidence to access a public physical space” like an H.I.V. testing clinic.

Mobile phone apps that connect youth to H.I.V. testing cannot supplant other proven H.I.V. prevention methods. Kids still need quality health education in school and optional school-based H.I.V. testing. Most important, kids need caring parents who support access to high-quality care.

My patient didn’t have access to any of these resources. Fearing fellow churchgoers would judge them for her diagnosis, her parents kicked her out of the house. She fought to finish high school while sleeping on a neighbor’s couch and struggled to take medications and keep her medical appointments. At 18 she moved to a new state, hoping to start a new life.

She and the 10,000 other young people in the United States given H.I.V. diagnoses every year deserve more. They need evidence-based sex education, supportive parenting and better access to the H.I.V. testing information that could save their lives.

Tim Lahey, M.D., M.M.Sc., is an H.I.V. physician, ethicist and director of education at the Dartmouth Institute for Health Policy & Clinical Practice in Dartmouth’s Geisel School of Medicine. He is a member of the Dartmouth Public Voices Fellowship.

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